Provider Demographics
NPI:1821399452
Name:JACOBSEN, DEBRA ANN (LMT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:PARFITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3414 1/2 EVERETT AVENUE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201
Mailing Address - Country:US
Mailing Address - Phone:425-905-8628
Mailing Address - Fax:
Practice Address - Street 1:3414 1/2 EVERETT AVENUE
Practice Address - Street 2:UNIT 1
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:425-905-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60180750225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist